Sandbox:Croup medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Medical Therapy
Glucocorticoids
- Corticosteroids are used to alleviate croup symptoms, effective beginning 6 hours post-treatment.[1]
- Symptom reduction is a result of reduced inflammation and swelling of the trachea.
- For croup cases of all severities, the following glucocorticoid therapies are recommended:[2]
- Dexamethasone: 0.60 mg/kg PO/IM/IV, single dose (max. 10 mg)
- Budesonide: 2mg nebulized
- Dosing is usually administered orally for mild cases, but a parenteral method may be used for severe croup.[3]
Epinephrine
- Epinephrine is indicated for moderate and severe cases of croup.[3]
- Symptoms are usually alleviated within 10-30 minutes, but typically return after 2 hours post-treatment.[4]
- Epinephrine is usually administered as follows:[4]
- Nebulized racemic epinephrine (2.25%): 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 minutes.
OR
- Nebulized L-epinephrine: 0.5mL/kg (max 5mL) for 15 minutes.
- Repeated as necessary.
- Nebulized L-epinephrine: 0.5mL/kg (max 5mL) for 15 minutes.
- Glucocorticoids are used in conjunction with epinephrine for moderate and severe croup cases.[2]
Heliox
- Helium and oxygen combined into "heliox" breathing gas can be used to alleviate croup symptoms by reducing upper airway obstruction.[5]
- Upper airway resistance to gas flow is reduced to relieve respiratory distress.
References
- ↑ Russell, Kelly F; Liang, Yuanyuan; O'Gorman, Kathleen; Johnson, David W; Klassen, Terry P; Klassen, Terry P (2011). "Glucocorticoids for croup". doi:10.1002/14651858.CD001955.pub3.
- ↑ 2.0 2.1 Petrocheilou, Argyri; Tanou, Kalliopi; Kalampouka, Efthimia; Malakasioti, Georgia; Giannios, Christos; Kaditis, Athanasios G. (2014). "Viral croup: Diagnosis and a treatment algorithm". Pediatric Pulmonology. 49 (5): 421–429. doi:10.1002/ppul.22993. ISSN 8755-6863.
- ↑ 3.0 3.1 Everard, Mark L. (2009). "Acute Bronchiolitis and Croup". Pediatric Clinics of North America. 56 (1): 119–133. doi:10.1016/j.pcl.2008.10.007. ISSN 0031-3955.
- ↑ 4.0 4.1 Bjornson, Candice; Russell, Kelly; Vandermeer, Ben; Klassen, Terry P; Johnson, David W; Bjornson, Candice (2013). "Nebulized epinephrine for croup in children". doi:10.1002/14651858.CD006619.pub3.
- ↑ Moraa, Irene; Sturman, Nancy; McGuire, Treasure; van Driel, Mieke L; Moraa, Irene (2013). "Heliox for croup in children". doi:10.1002/14651858.CD006822.pub4.